Mind Wars: Fighting the War at Home

Washington (Tenley Times) – Scott Powell’s realization of what war truly meant came one day in 2007 while serving in Al Asad Airbase in northwest Iraq. Cpl. Powell, 23, a marine, was assigned to a health service support company with Navy doctors, acting as a liaison between them and the hospital in Al Asad. He was doing his daily job of processing dead bodies when a badly injured Iraqi child came into the hospital from a school that was bombed near Al Asad. Powell remembers the doctors cracking open the boy’s chest attempting to bring him back to life with a heart massage, but the boy passed away. As he was processing the body, the boy’s father came in, wanting to see his son and pray to Allah. The boy’s father entered the room and was looking for a prayer rug, as custom with Islamic tradition, but could not find a rug. However, there was a stack of black body bags near his dead son lying in a hospital bed. As Powell entered, the room in the hospital, he found the father of the dead boy praying to Allah on one of the empty black body bags next to his dead son. That’s when it hit Powell, this is war; but he had to move on, because it is what he was trained to do at that moment.

“It was hard to process those things in Iraq, those are some deep human emotions for something like that can invoke,” said former Sgt. Powell, now 29, a student at American University scratching his bushy brown beard. “This phrase gets cliché it’s almost that stuff gets bottled up and those things can only stay in there before they start to ferment. Eventually, pressure builds up in the bottle, I wouldn’t say you have an explosion, but the top pops off and those things come oozing out and you have to confront those things.”

This was just one day of the seven months that Powell spend in Iraq from Valentine’s Day 2007 to September 11, 2007, processing dead bodies at Al Asad Airbase. He dealt with body after body, young, old, men, women, children, friend, foe and everything in between. Yet, his training told him not to process what was happening and told him to move on from the beginning to the end of his deployment. He was not told what he would be doing in Iraq. A year later, Powell’s scenes of war began to manifest in his mind. He had seen so much and did not process it, everything was coming back.

Powell was suffering from post-traumatic stress disorder (PTSD). PTSD is a mental health issue that possibly can occur after a horrific event like war or other traumatic events. PTSD has six common symptoms including: reliving the traumatic event, avoiding situations that remind someone about the event, feeling numb, hyperarousal, the previous symptoms occurring over a month and significant impairment. However, PTSD has gained more public awareness due to the recent conflicts in Iraq and Afghanistan, but PTSD is growing problem especially with more veterans returning home. According to the 2012 Department of Veterans Affairs report, nearly 30 percent of veterans from Iraq and Afghanistan have been diagnosed with PTSD.

PTSD in Today’s America

The 2012 Veterans Affairs report has placed a new emphasis on providing treatment for veterans who are suffering from PTSD. Currently, there are three treatments recommended by VA which are: Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing and Selective Serotonin Reuptake Inhibitors. However, there is a strong stigma against getting treatment due to fears of getting dishonorably discharged or not receiving a promotion.

Derek Coy, a former marine and development associate at the Iraq Afghanistan Veterans of America, the stigma caused him to ignore signs of PTSD that began to manifest themselves during his third deployment on the USS Essex.

“I fell victim to these stigmas, but I knew that things were not right,” said Coy. “I knew something was wrong, but I did not want to be able to deploy with my unit, I did not want something to happen to me because I was not deployable or that I can’t fight anymore. So, I chose to suppress my emotions, I didn’t know any better, so I just thought that I would get over it.”

However, after his deployment on the USS Essex, Coy began to feel worse once his left the Marines and a psychologist diagnosed him with PTSD and demand him to seek out help. Today, Veterans Affairs has a few basic treatments for those suffering from PTSD.

Cognitive Behavior Therapy is a psychological, therapeutic approach that addresses mental processes through goal oriented procedures. A common form of this kind of treatment for veterans is desensitization, where a person is exposed to the traumatic event and/or encouraged to remember it. The theory is that people give meanings to an event and make it an experience. Also, the person becomes less and less frightening with constant exposure.

Another common treatment for PTSD today is eye movement desensitization and reprocessing (EMDR). This treatment involves focusing on distractions like movement of other extremities and sounds while you talk about the traumatic event.

“Clients need to change the meaning that they have given to witnessing a massacre, the death of a buddy, an accidental killing of a civilian, etc., and relieve themselves of the guilt, shame, anxiety, and depression that they have been saddled with for years,” said Dr. Stanley Krippner, 80, a professor of psychology at Saybrook University and author of Haunted by Combat: Understanding PTSD in War Veterans. “For example, a solider might say, ‘I am a no-good murderer because I killed an Iraqi girl who was carrying a doll that I thought was a bomb.’ This needs to be changed to, ‘Terrible things happen in war. A part of me died too. But I am going to spent time with handicapped children as a volunteer in her memory.’ In this way, post-traumatic stress can be changed to post-traumatic strengths.”

Selective Serotonin Reuptake Inhibitors (SSRIs) are medications recommended by the VA for those suffering from PTSD. Two common SSRIs are Zoloft and Paxil. However, Dr. Krippner believes that medication is only a short term solution.

“I think that mainstream medication should be used short-term rather than long term because of its side effects,” said Krippner. “And there are studies showing that psychotherapy is just as effective as medication, especially for the depression that often accompanies PTSD and is a frequent predictor of suicide.”

After Powell was diagnosed with PTSD in late 2008, he received outpatient psychiatric treatment at the National Naval Hospital (now the Walter Reed National Medical Center) in Bethesda, MD. Powell’s treatment involved seeing a psychologist and psychiatrist. He received a treatment known as biofeedback. Biofeedback is a therapy where are patient gain greater awareness of their physical functions, similar to eye movement desensitization and reprocessing.

Besides various medical treatments, there are organizations that support returning veterans from Iraq and Afghanistan. Some of these organizations include: the Wounded Warrior Project, Veterans of Foreign Wars and the Iraq and Afghanistan Veterans of America. The Iraq and Afghanistan Veterans of America or IAVA is the first and largest nonprofit, nonpartisan organization for veterans of those wars. This group that is built upon four tenants: supporting new veterans in health, education and employment while building a lasting community for vets and their families.

For Coy, this organization was a literal lifesaver. Coy served two back-to-back tours of duty in Iraq from August 2005 to August 2006. Coy delivered aviation parts to airfields. However, Coy began to notice problems during this third deployment on the USS Essex, but did not want to say anything. After his third deployment, he left the Marines and that is when he began to suffer from PTSD. He moved to New York City in fall 2010 when he was at his “lowest point”, but everything changed one day.

“I decided to go to the Veterans Day Parade and march with IAVA in 2010 and once I got there my life changed,” said Coy, now a development associate at the IAVA. “They welcomed me with open arms and since that day I’m completely indebted to them. I have no qualms in saying this organization saved my life.”

The various medical treatments for those suffering and the support networks for veterans have given veterans some relief right now. In the past, few in the public knew the horrors of PTSD and while progress has been made in the present there are still many challenges in the future.

Historical Perspective of PTSD

While attempts of spotlight the problem previously, PTSD did not gain widespread public attention until 2005. In December 2005, Joshua Omvig, 22, a member of the 339th Military Police Company, committed suicide after returning that Thanksgiving from Iraq. Omvig’s suicide was a national wake-up call for the rising number of veteran suicides after veterans began returning from Iraq and Afghanistan. Omvig became the human face of the first legislative attempt to help control the number of veteran suicides, which was called the Joshua Omvig Veterans Suicide Prevention Act of 2007. The bill was designed to develop and implement a comprehensive program designed to reduce the incidence of suicide among veterans. President Bush signed the Act into law on November 5, 2007.

In February 2007, The Washington Post ran a series called “Walter Reed and Beyond”, written by Dana Priest and Anne Hull, which exposed systematic mistreatment at Walter Reed and beyond. Walter Reed at that time had no specific PTSD center, even though they had the nation’s largest psychiatrist facility, and patients rarely received individual attention. The series led the resignation of three top military officials, an extensive review of Veterans Affairs and President George W. Bush to appoint the President’s Commission on Care for America’s Returning Wounded Warriors.

In 2007, Veterans Affairs released a report which found that the 17 veterans per day committed suicide. Stress-related illness was a major reason cited for why many veterans committed suicide. In 2012, a V.A. report showed that since 9/11, nearly 30 percent of the 834,463 Iraq and Afghanistan War veterans treated at V.A. hospitals and clinics have been diagnosed with PTSD. Even more disturbing, the V.A. three weeks ago released a report saying that in 2012, 22 veterans a day committed suicide, a 20 percent increase from 2007.

On February 5, 2013, Eddie Ray Routh, 25, killed Chris Kyle, a former Navy SEAL and American Sniper co–author. Kyle’s death received national attention. Routh, according to law enforcement records, had been taken to a mental hospital twice in the past five months and told authorities he was suffering from PTSD.

“PTSD is one of those things that is tearing apart our community because a lot of people don’t know really what it is about and don’t have information on this topic,” said Coy.

What Challenges Remain in the Future?

One treatment that has recently gained traction is virtual reality therapy. Virtual reality therapy is a new type of re-exposure therapy that generates an artificial world and combines other sensory effects to simulate combat experiences of veterans in a virtual world with a therapist to help them understand the experience. Early clinical trials have yielded positive results, but the cost of the technology is a downside to this type of therapy.

While this treatment is a future option, there are a number of challenges facing the veteran community with PTSD. One of the huge challenges that face the military and veteran communities is the stigma against psychological treatments. Dr. Krippner said that in the military the general stigma of going to a psychotherapist for any psychological problem is heightened.

“Many veterans, male and female, sometimes think it is a sign of weakness, or that it will appear on their record and ruin their chances of promotion or advancement,” said Krippner. “The armed forces are taking steps to counter and oppose these stereotypes but more needs to be done.”

Another challenge facing veterans is the lack of facilities for long term rehabilitation. Coy said that the V.A. is overwhelmed with the influx of veterans suffering from PTSD.

“Everything is bursting at the seams,” said Coy. “The V.A. did not beef up their staff, they did not anticipate all of the mental health problems that would occur over these last 12 years. They simply do not have the resources to take care of all the vets that need help.”

The Iraq and Afghanistan Veterans of America has stepped up in a huge way by creating the Rapid Response Referral Program. This program connects with veterans struggling with suicidal ideation and a variety of other transition-related challenges with medical resources. Another program that the IAVA has created is Community of Veterans, the first and largest online social network exclusively for Iraq and Afghanistan veterans to connect over their shared experiences.

“The best thing that we can do is get the word out there,” said Coy. “Unfortunately, I fell victim to this myself you just get those stigmas and the stereotypes in your head and unless you know otherwise, it is really hard to debunk them. A lot of people think of when they think of PTSD they think of Rambo, someone that goes on a shooting spree, or something crazy like that and statistical that is not the case.”

For Powell, six years after his experience in Iraq, he is now able to process his experience of dealing with bodies in Al Asad. He stills suffers from PTSD, but is able to put that time into proper context. Powell is now in his second semester studying at American University. He walks around campus wearing a red Washington Nationals hat, an American University hoodie and jeans. Powell has a bushy brown beard and gained some weight from his military days. He feels that has been able to gain a sense of peace since his experience in Iraq.

“It has been over six years since I first deployed and you can interpret things a lot differently after you have had a little time to look at them,” said Powell. “Go seek some type of medical help, it is really not that bad of a thing and the things that it can lead to if it goes untreated nobody wants that to happen. We have seen past examples to what kind of stuff people who have it, but never get treated for it. It is going to serve you a lot better to receive treatment than not getting it.”